Provider Demographics
NPI:1174623300
Name:MICHAEL, LEORA H (DDS)
Entity type:Individual
Prefix:DR
First Name:LEORA
Middle Name:H
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3028
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3028
Mailing Address - Country:US
Mailing Address - Phone:417-781-6222
Mailing Address - Fax:417-781-1278
Practice Address - Street 1:1329 E.32ND SUITE 6
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-781-6222
Practice Address - Fax:417-781-1278
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0151411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice